Pa. will offer money for organ donation

$300 will be offered to help families cover funeral expenses

WASHINGTON -- With demand for human organs far outstripping supply and more than 64,000 Americans waiting to receive hearts, lungs, livers, pancreases and kidneys, Pennsylvania is taking steps to become the first state to break a long-held taboo against providing a financial reward for organ donation.

By early next year, state health officials said recently, they will begin offering a stipend of about $300 to help families of organ donors cover their funeral expenses. The stipend, authorized by a 1994 law, will be paid to funeral homes and not directly to relatives under a pilot project that will be monitored for three years by a panel of medical ethicists to see if it increases organ donations.

Final details of the project are being worked out by a panel of advisers to Gov. Tom Ridge, a Republican. The panel is expected to issue its recommendations on June 9. A spokesman for the governor said he knew of "no impediment" to the plan. If Ridge approves the program, the state Health Department will sign contracts with Pennsylvania's two organ-procurement agencies to begin making the payments as quickly as possible.

"We are all ready to move forward," said Emilie Tierney, the state health official supervising the project. "We expect other states to be watching us."

Also watching is the federal government, which says the payments may violate the National Organ Transplant Act, a 1984 law that classifies human organs as a national resource and prohibits their sale. And the plan is generating intense debate among transplant surgeons, organ recipients and families of donors.

"This is absolutely not buying and selling organs," said Howard Nathan, who serves on the governor's advisory panel and is president of the Gift of Life Donor Program, one of two regional networks that distribute donated organs in Pennsylvania. "This is about having a voluntary death benefit for a family who gave a gift. The intent is to test it and see if it makes a difference to families."

But the federal Health Resources and Services Administration, which oversees the nation's transplant programs, is not so certain.

"The federal statute is fairly clear in prohibiting the exchange of organs for any kind of payment," said Jon Nelson, who directs the agency's office of special programs. "The question is whether this is in violation of the statute or not. Clearly, we have to look at it closely."

Even if the payments are legal, critics say they raise questions: Will the promise of a stipend, however small, induce families to lie about the medical histories of their loved ones, withholding information that could affect the health of the transplant recipient?

Will the money prompt a disproportionate increase in donation among the poor, injecting further economic imbalance into a system that is already skewed in favor of the wealthy? Will the plan backfire, hindering organ donation by offending families who believe their gift is tainted by payments?

And, finally, in an era when surgeons are routinely transplanting kidneys from living donors who are not related to the recipients, could the stipends mark the first step on the road toward outright sale of organs?

"I think it is very murky ground to get into when we put a monetary incentive for such an altruistic gift as organ donation," said Antonio Benedi, a liver recipient and past president of Transplant Recipients' International Organization, a nonprofit group in Washington. "Obviously there are some folks that need help as far as funerals go, but to attach it to the actual donation, I think, is very dangerous."

Some transplant surgeons echo his view.

"Society is not prepared to allow for your body to be bought and sold," said Dr. Francis L. Delmonico, director of the kidney transplant program at the Massachusetts General Hospital in Boston. Delmonico is also medical director of the New England Organ Bank, the nation's oldest organ-procurement agency, and although that organization has not taken a position on the stipend, he said he felt compelled to offer his personal views.

"I don't have a fundamental objection to compensating families," he said. But, noting that organs are sold on the black market in some nations, he said he worries that "this would be a slippery slope toward the buying and selling of organs, which is federally prohibited."